Chinese Medicine, 2011, 2, 77-83
doi:10.4236/cm.2011.23014 Published Online September 2011 (
Copyright © 2011 SciRes. CM
Gynecology and Gynecological Nursing Theories and
Practices in Traditional Chinese Medicine: Review
on the Ancient Literatures
Xiangeng Zhang1#, Hui Zhang2#, Xiaoli Liang1, Qin Liu1, Miqu Wang2*
1Nursing School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
2Genetics Laboratory, Chengdu University of Traditional Chinese Med icine, Chengdu, China
E-mail: *
Received April 26, 2011; revised May 8, 2011; acc epted May 13, 2011
Objective: the study is aimed to introduce the developing history of gynecology and gynecological nursing in
traditional Chinese medicine (TCM). Study Design: the dev elopment of gynecology and gynecological nurs-
ing consists of six periods in Chinese history. They are: 1) budding stage represented by the inscription s of
(female) on oracle bones; 2) physiological development stages of wo men; 3) specialized chapters of gynecol-
ogy in TCM; 4) features of gynecological nursing; 5) monograph of gynecology and gynecological nursing; 6)
integration of ancient gynecological nursing perceptions. Results: TCM has a profound understanding of gy-
necology and gynecological nursing. For period one, the inscriptions of (female) on oracle bones is the
symbol of the budding stage. For period two, physiogenesis stages of women are record ed in The Yellow Em-
peror of Classics of Inner Medicine. For period three, the specialized chapter s of gynecology appeared, repre-
sented by Golden Chamber, Woman . For period four, the features of gy necological nursing were elaborated in
Essential Prescriptions Worth A Thousand Gold including menstruation, depression, yin-dampness, and
menopause. For period five, monographs of gynecology and gynecological nursing represented by Good
Comprehensive Woman Formulae appeared. For period six, Integrative studies of gynecological nursing per-
ceptions were carried out with the representation by Integrated Ancient and Modern Books. Conclusion:
TCM gynecology and gynecological nursing harbors a long history of treating and nursing gynecological dis-
orders. With therapeutic and nursing modalities, they are effective systems of understanding and managing
woman health as proven by medical literatures, clinical benefits and basic research studies.
Keywords: TCM Gynecology, TCM Gynecological Nursing, Traditional Chinese Medicine (TCM)
1. Introduction
TCM, a medical system of diagnosis and health-care
approaches, has a long history of over 2000 years. It has
evolved into a well-developed, coherent system of me-
dicine that uses several modalities to treat and prevent
illness. The most common ly applied therapeu tic methods
include acupuncture, moxibustion, herbal remedies, diet,
meditation, and both static and moving exercise [1,2]. In
TCM, gynecology is one of the main branches with
unique features [3]. The developing history of TCM gy-
necology, abundant gynecological nursing theories, ap-
proaches, and concepts are involved. Extensive litera-
tures are recorded on disorders of menstruation, leu-
corrhea, pregnancy, delivery, lactation, and etc. [4]. There
are specialized chapters, monographs available on nurs-
ing which is not inferior to gynecological, obstetric, and
reproduction nursing cognitions in ancient Greece [5],
Rome [6], Egypt [7], and India [8]. TCM has increasing
popularity worldwide especially for acupunctural and
herbal therapy for pain, diabetes, menopause syndrome
(MPS) and other chronic diseases. It’s very important to
fully understand the developing course of a specific field.
Only in this way, can the practitioner have an all-round
perception of a subject. Zhang et al. [9] reviewed the
developing history of diabetes in TCM. To our know-
ledge there is yet no review on the developing history of
TCM gynecology and TCM gynecological nursing in
#These two authors contribu t e e q u al l y t o th i s w o rk.
published literatures. However nowadays, the under-
standing of gynecological nursing of TCM is merely
limited and awaits popularization. We extensively and
intensively mined the literates on TCM gynecological
nursing to draw rational attention to this unique nursing
system. TCM gynecology and nursing have a compre-
hensive coverage of woman’s disorders including men-
struation, coitus, fertilization, antenatal training, preg-
nancy, dystocia, children rearing, and women’s hygiene,
daily care, activities, emotion, diet, psychology, remedy,
massage, and gereology [10]. This study might broaden
the knowledge of gynecology and gynecological nursing.
2. Methods
The development of gynecology and gynecological nurs-
ing in TCM consists of six periods in the recorded Chi-
nese history based on Zhang’s classification of Chinese
medical history and the periodization of China’s history
[9]. The developing history includes as follows: 1) bud-
ding stage represented by the inscriptions for (female )
on oracle bones, 1700 B.C.-256 B.C., (Sang dynasty-
Zhou dynasty); 2) physiogenesis stages of woman re-
corded in The Yellow Emperor of Classics of Inner
Medicine (Huang Di Nei Jing), 256 B.C.-8 A.D. (Zhou
dynasty-Western Han dynasty); 3) the specialized chap-
ters of gynecology in TCM represented by Golden
Chamber, Woman (Jin Kui Yao Lüe·Fu Ren Pian), 8
A.D.-589 A.D. (Xin Dynast- Northern and Southern dy-
nasties); 4) features of gynecological nursing in TCM
represented by the content in Essential Prescriptions
Worth A Thousand Gold (Qian Jin Yao Fang), 589-960
(Sui dynasty-Five Dynasty); 5) monograph of gynecol-
ogy and gynecological nursing in TCM represented by
Good Comprehensive Woman Formulae (Fu Ren Da
Quan Liang Fang), 960 A.D.-1368 A.D. (Song dynasty-
Jin and Yuan dynasty); 6) integration of ancient gyneco-
logical nursing perceptions represented by Integrated
Ancient and Modern Books (Gu Jin Tu Shu Ji Cheng),
1368 A.D.-1912 A.D. (Ming dynasty-Qing dynasty). All
the representative literatures have a high reputation in th e
field of Chinese medical literatures with their irreplace-
able status and role in the development of gynecology
and gynecological nursing in TCM.
3. Results
3.1. Budding Stage Represented by the
Inscriptions for (Female) on Oracle
Bones (1700 B.C.-256 B.C.)
Oracle and bones inscription was the first mature script
of China over 3000 years ago, which was used to divine
and record in royal. The character of (Figure 1, I) in
this script system means a woman sitting straight with
hands crossing and legs bending. In the same system,
plenty of characters related to were discovered such
as Mu (mother), Mei (each), Yun (pregnancy), Yu (deliv-
ery), Fu (woman), Ren (gestation), Hao (good), Ru
(breast), and so on (Figure 1).
There are various characters in Chinese language
based on and Mu represented by Yun, Yu, and Ru.
Yun (Figure 1, IV) consists of on the top of Zi (in-
fant), which means a potbellied woman with a big head
fetus inside the abdomen. Yu (Figure 1, V) consists of
on the upper-left side of bleeding Zi, which means a
woman is delivering and bleeding. Ru (Figure 1, IX)
consists of woman surrounding a neonate, which means a
mother is holding and breeding a baby with exposed
breasts. It can be seen that in oracle and bones inscript i on,
life and generation are reflected by the status of a mother
holding a baby. Her gesture, having knees bent, breasts
exposed and baby held, is the most graceful script. Yun,
Yu, and Ru are amazing annotations of the three courses
of woman: pregnancy, delivery, and fostering. Mean-
while Hao (Figure 1, VIII) consists of a male on the left
side of a female, which means good and beautiful and is
employed to praise above courses. Oracle and bones in-
scriptions also have lively records on the courses of
pregnancy and fostering. For instance, divinatory sym-
bols indicating the good and ill luck of pregnant woman
and fetus, dystocia and parturient disease. Meanwhile
there is a certain name of all the gynecological disorders,
Ji Yu or illness of gestation [11].
Figure 1. Oracle and bones inscriptions correlated to .
Copyright © 2011 SciRes. CM
Copyright © 2011 SciRes. CM
3.2. Physiological Growth and Development
Stages of Woman Recorded in The Yellow
Emperor of Classics of Inner Medicine
(Huang Di Nei Jing), 256 B.C.-8 A.D.
The Yellow Emperor of Classics of Inner Medicine
(Huang Di Nei Jing) is the an agglomeration of Chinese
life science before 8 A.D., which is the foundation of
TCM including physiology, pathology, anatomy, psy-
chology, health prevention, yin yang, five elements, me-
ridian, organs, etiology, pathogenesis, diagnosis, and
therapy [12]. It also documents the physiological deve-
lopment of woman and gynecological disorders. It is in
the first chapter that the whole growing course are dis-
cussed (Table 1).
In this book, various gynecological disorders and their
pathogen, diagnosis and principle of therapy are involved,
such as infertility, amenorrhea, aphonia during prenatal
period, leukorrhagia, Zheng Jia (concretions and con-
glomerations), large intestine cancer, and uterine cancer.
Meanwhile, the first gynecology formula is recorded in
the book, Si Wu Zei Gu Yi Lu Ru Wan (four of cuttlefish
to one of madder pill) which is used to treat threaten
abortion, uterine bleeding, and leukorrhagia. It can be
seen that TCM already had deep understanding of gyne-
cological disorders, which also gave birth to gyneco-
logical nursing in TCM.
During the period 256 B.C.-8 A.D, genealogical litera-
tures were found in non -medical bo ok s. The First Year of
Zuo Zhao (Zuo Zhao Yuan Nian) discusses the pathogen
of genealogical disorders. Zuo Zhuan records the close
relationship between physiology and psychology which
can interact. It also records that woman is susceptible to
psychology illness because of over-thinking, over-work-
ing, and irritability. All the documentations imply the
sprout of nursing of psychology, diet and daily life.
3.3. Special Chapters on Gynecology in TCM
Represented by Golden Chamber, Woman
(Jin Kui Yao Lüe, Fu Ren Pian),
8 A.D.-589 A.D.
Zhongjing Zhang wrote the first specialized chapters on
gynecological disorders, Golden Chamber, Woman (Jin
Kui Yao Lüe, Fu Ren Pian) which discussed gestational
disorders, postpartum disorders, and gynecological mis-
cellaneous diseases separately in three chapters. They are
Chapter 20, Disease, Pulse, Syndrome and Treatment of
Pregnant Woman (Fu Ren Ren Shen Bing Mai Zheng),
Chapter 21, Disease, Pulse, Syndrome and Treatment of
Postpartum Woman (Fu Ren Chan Hou Bing Mai Zheng
Zhi), and Chapter 22, Miscellaneous Diseases, Pulse,
Syndrome and Treatment of Woman (Fu Ren Za Bing
Bing Mai Zheng Bing Zhi). His understanding on gyne-
cology has been playing directive role for later re-
searches. The book involves the physiological features
and all-round disorders of women. For instance, it is re-
corded in Chapter 21 that, there are three possible dis-
eases for women who have just given birth, convulsion,
Yu Mao (dizziness, vertigo and depression) and dys-
chezia. The pathogenesis of convulsion is that a newly
delivered woman has blood deficiency and hidrosis, and
is susceptible to have wind invaded. The pathogenesis of
Yu Mao is that blood collapse and hidrosis lead to cold.
The reason of dyschezia is exhausted fluids and stomach
dryness. Therefore, he has been honored as the initiator
who was specialized in treating gynecological disorders
as an interdependent disease.
Zhang’s gynecological nursing theory adheres to her-
bal treatment based on the perception of gynecological
features, nursing during the entire process, combinational
use of herb and diet, and concern of personal hygiene. In
Golden Chanmbe, Disease, Pulse, Syndrome and Treat-
Table 1. Physiogenesis stages of woman recorded in The Yellow Emperor of Classics of Inner Medicine (Huang Di Nei Jing).
Age Bracket (years) Wane and Wax of Qi Physiological Sings
0 - 7/first Seven Ascending kidney Qi Dental transition, growing hair
8 - 14/second Severn Smooth of Ren meridian and ex c e s s o f Taichong meridian Arrival of T i a n G ui (menstuation), pregnancy
15 - 21/third Seven Mean kidney Qi Genuine tooth
22 - 28/fourth Seven Hardened bone and sinews Extremely lengthened hair, strong constitution
29 - 35/fifth Seven Descending Qi of Yangming meridian Beginning of gaunt face and hair loss
36 - 42/sixth Seven Deficiency of upper triple-yang (Taiyang, Yangming, Shaoyang) General gaunt face, beginning o f whiten ing h air
43 - 49/seventh Seven Deficient Ren meridian, reduced Taichong meridian, Menopause, and inability of fertility
Copyright © 2011 SciRes. CM
ment of Postpartum Woman, Dang Gui Sheng Jiang
Yang Rou Tang (tangkuei, fresh ginger, and goat meat
decoction) is used to treat mild and persistent abdominal
pain. The formula consists of Dang Gui (Angelicate
Sinensis Radix) a blood supplementing herb, ginger, and
goat meat, which indicate his assertion of diet-herb ther-
apy and the feature of herbal care in TCM. He also
pointed out each disease requires different daily life con-
siderations. If the considerations are favorable, the dis-
ease is readilier to be cured. Otherwise, the disease is
harder to be cured. In summary, individual and locality
oriented analysis is necessary to carry out a on-demand
nursing based on patt ern different i at i on [1 3 ].
3.4. Features of TCM Gynecological Nursing
Represented by the Record in Essential
Prescriptions Worth a Thousand Gold
(Qian Jin Yao Fang), 589 A.D.-960 A.D.
Simiao Sun (581-682) wrote an outstanding medical
book named Essential Prescriptions Worth A Thousand
Gold (Qian Jin Yao Fang). In his book three gynecology
chapters were for the first time placed prior to internal
medicine, which indicates the presence as an independ-
ent field. In Chapter 1, Generation Demands (Qiu Zi Di
Yi), mind-body features of woman is discussed. The
treatment of gynecological disorders is complicated be-
cause of the physiological features of menstruation, leu-
corrhea, pregnancy and delivery essential to the first
perception which both medical and nursing practitioners
must understand.
He has deep perception on menstruation (physiolo gy),
depression (psychology), yin-dampness (pathogenesis),
and menopause (pathology). He advocates that not only
doctor and nurses are responsible for the four issues, but
also the parents, husbands and offsprings should be con-
cerned. Thus, a special medical care mode with self-care
and family care was formed. In this book abundant de-
tails on gynecological nursing were recorded. For in-
stance, when giving birth, the room must be quiet, and
the parturient must keep a quiet mood to bear pain and be
patient with slow parturition.
3.5. Monographs of TCM Gynecology and
Gynecologic Nursing Represented by Good
Comprehensive Woman Formulae (Fu Ren
Da Quan Liang Fang), 960 A.D.-1368 A.D.
When the history of TCM came to the period from Song
dynasty (960-1279) to Yuan dynasty (1271-1368) a de-
velopment summit appeared during which the famous
“four schools o f Jin and Yuan” formed and TCM nursing
achieved an in-depth growth. In that period, monographs
of separated clinical departments appeared, such as Good
Comprehensive Woman Formulae (Fu Ren Da Quan
Liang Fang) written by Ziming Chen, publish ed in 1237,
and Secretes of Pediatric Herbs and Syndrome (Xiao Er
Yao Zheng Zhi Jüe) written by Yi Qian, published in
1114. Dongyuan Li (1180-1251) wrote Treatise on the
Spleen and Stomach, Nursing Methods of Spleen and
Stomach (Pi Wei Lun, Pi Wei Jiang Li Fa). With the ap-
pearance of specialized clinical monographs, departmen-
tal nursing took shape. Altogether there are more than
ten monographs on gyne cology and obstetrics.
For instance, Treaties on Ten Dystocias (Shi Chan Lun)
written by Zijian Yang in 1098, discussed the pathogen,
symptom and aids of ten abnormal deliveries, cro ssbirth,
footling presentation, obliq ue presentation, injured labor,
induced spawning, frozen delivery, heat delivery, um-
bilical dystocia, sitting position labor, and rolled intestine
delivery. The correcting technique of crossbirth or ac-
romio-iliac presentation, a representative technique in
dystocia nursing, was 500 years earlier than th e record in
Good Comprehensive Woman Formulae (Fu Ren Da
Quan Liang Fang) has been regarded as the agglomera-
tion of gynecology in TCM. It also presents plenty of
gynecology nursing issues. There are various chapters
named after nursing su ch as Antenata l Education, Avoid-
ance and Nursing of Child Destruction before Delivery
(Tai Jiao Meng, Tai Sha Bi Ji Chan Qian Jiang Hu Fa),
Gestation, Gestational Remedy and Nursing Along with
the Age of Fetus (Ren Shen Sui Yue Shu Fu Yao Ji Jiang
Xi Fa), Puerperium Care, Nursing of Puerpera (Zuo Yue
Men, Jiang Fu Yun Fu Lun), Postpartum, Regulation of
Postpartum (Chan Hou Men, Chan Hou Tiao Li Fa), and
Postpartum, Nursing of Postpartum (Chan Hou Men,
Chan Hou Jiang Hu Fa). Meanwhile there are abundant
documents on the principles, methods, and details of
gynecological nursing. For example, the nursing of men-
struation and virginal bleeding must focus on Xue or
blood, because only when blood is harmonized, can Qi
(the circulating life energy) be harmonized and fetus be
safe and delivery be successfully. Another example is
that the nursing modalities of rich woman differ from
poor woman. Rich woman should not relax in comfort or
pleasure, because the lack of exercise gives rise to Qi
stagnation and immobility of fetus, which eventually
leads to dystocia.
3.6. The Integration of Ancient Gynecological
Nursing Perceptions Represented by
Integrated Ancient and Modern Books
(Gu Jin Tu Shu Ji Cheng),
1368 A.D.-1912 A.D.
Ming Dynasty and Qing dynasty are the late stage of
ancient China. The integrated study on medical books
has achieved obvious development in those periods; par-
ticularly over one hundred comprehensive medical mo-
nographs are cultivated during that time. Most of the
comprehensive monographs contain extensive gyneco-
logical and gynecological nursing contents. For instance,
Zhang's Medical Book (Zhang Shi Yi Tong) written by
Shiwan Zhang (1617-1700) includes one chapter named
Facing Perinatal Disorders (Lin Ru) in which 13 issues
are discussed, such as Fu Chi or nursing aid, Shang Tai
or bleeding, Gan Tai or premature rupture of membrane
(PROM), Nan Chan or dystocia, Chan Bian or abnormal
phenomenon of labor, Mo Chuai or relieving labor pain,
Wo Fa or labor gesture guide, Cui Sheng or expediting
child delivery, and Yin Shi Yi Ji or proper and improper
life styles. In another book, Ancient and Modern Books,
Comprehensive Medical Books (Gu Jin Tu Shu Ji Cheng
Yi Bu Quan Lu), Gynecology (volume 381 - 400) em-
bodies over 100 ancient gyneco logical boo ks in which 21
books about perinatal care and 187 formulae are in-
In the developing history of gynecological nursing in
TCM, fetus fostering and fetus education are two unique
issues. They initiated in Jin dynasty (266 -420) and raped
in Ming dynasty (1368-1644). Fetus foster ing and educa-
tion have varied and extensive contents including fetus
fostering according to different months, formula, sur-
rounding, emotional condition, diet and nutrition, and
contraindication (Table 2). Moreover, it involves mate
selection, preparation for fertilization, sperm cultivation
for man, and blood cultivation for woman. The narrow
Table 2. Summary of the understandings of fetus foster i ng and e duc ation.
Under sta ndi ng on Fe tu s Fetus Fost er ing an d Ed uc ati on Disea se
Months Meridian Form of
embryo Physiology Daily life
considerations PsychologyDiet Formula
Forbidde n
meridian f or
First Foot Jueyin
liver (L)
The beginning
of embryo,
of Jing
(essence) Qi
Sleep wit h quiet
surrounding Avoidance
of fear Flour and
Wu Ci Ji Tang
chicken decoction)
and less
Second Foot
gallbladder (G)
The beginning
of fat, peac h-
blossom-like Live with quiet
surrounding Careful
care No acrid
Ai Ye Tang
(mugwort leaf
gallbladder Arthralgia
Third Hand Shaoyin
heart (H)
Formation of
blood and
What the mother
see can affec t th e
development of
of grief Xiong Ji Tang
(cock decoction)
small intestine
sexes Formation of
six Fu organs Reduced physical
activity Peaceful
mood Rice and
Ju Hua Tang
Fifth Foot
Formation of
Formation of
five Zhang
Avoidance of
cold wind Avoidance
of horror Lam b and
E Jiao Tang
gelatin decoction)
spleen Vert igo
Sixth Foot
stomach (ST)
Formation of
eyes and
formation of six
Fu organs Walk outside Avoidance
of terrify Sw eet
Mai Men Dong Tang
Radix decoction)
Seventh Hand
lung (L)
Generation of
hair (on the
head and
Formation of
bone Gently physic al
activities Avoidance
of panic No cold
Cong Bai Tang
(onion white
large intestine
and fever
large intestine
Mobility of
fetus right
Formation of
skin Forbidden of
sudden sitting up
emo ti on a n d
No dry or
fried foodsShao Yao Tang
(paeonia decoction)
Overacti ve
Ninth Foot
kidney (K)
Ability of
physical to
Entry of Food
Qi into
stomach Loose clothes Easily
contented Sweet wine
and foodsBan Xia Tang
(pinellia decoction)
qi invading
upward to
Tenth Formation of
five Zang
Fully formation
of body and
Herbs promoting
Copyright © 2011 SciRes. CM
Copyright © 2011 SciRes. CM
meaning of fetus education basically refers to favorable
psychological condition which affect embryo through an
unknown communication pathway. In other words, what
the mother thinks, sees, talks and does are prenatal pa-
rameters for postnatal development of fetus. Fetus edu-
cation consists of harmonizing emotion, cultivation of
knowledge, influence of environment, sexual abstinence,
and good deeds.
4. Discussion
Inscriptions on oracle bones such as (woman) and Mu
(mother) 3200 years ago provide truthful evidence of
ancient female behaviors like pregnancy, regeneration,
and lactation. The inscriptions and literature of the names
of gynecological disorders show the theoretical budding
of female, gynecological, and obstetrical nursing. This is
premature than other civilizations, medical systems, gy-
necology histories, and nursing histories [7]. As a branch
of TCM, TCM gynecology and TCM gynecological
nursing has developed precociously according to the re-
cord in The Yellow Emperor of Classics of Inner Medi-
cine. Nowadays gynecology and gynecological nursing
in TCM are still beneficial to woman [14-16].
The developing history of TCM is never interrupted
by the turbulent Chinese history with dynastic change
and regime separation. The six stages are continual de-
velopments and sustainable growth. Gynecology and
gynecological nursing in TCM has been developing fol-
lowing the core principle of TCM or holism [17]. For
thousands years, Chinese women have trusted traditional
Chinese medicine to help them conceive. Gynecology
and gynecological nursing originate from practices and
are applicable in both TCM and w estern medicine. How-
ever, TCM nursing attaches importance to functional
regulation, while western medicine nursing to anatomy
and experiment [18]. Although TCM has rough percep-
tion of uterine, breast, virgin, and fetus, but TCM advo-
cates to Zang Xiang (organs and their manifestations)
rather than intensiv e anatomic study [19]. Table 2 shows
metaphors if fetus of different months. Nevertheless the
exact forms of fetus are not the emphases of TCM gyne-
cology. TCM lays stress on the importance of functional
regulation and adequate correct educational information
for gravida [20]. All the ancient understanding about
gynecological nursing approaches in TCM has been
proven applicative, effective, simple, and feasible, which
might be popularized.
Besides the conventional therapeutic and nursing
strategies, TCM is performed in professional clinical
practices and is showing a bright future in treating gyne-
cology disorders, with its altern ative approaches include-
ing acupuncture, moxibustion, herbal remedy, qigong,
etc. [1]. There are plenty of reports on the beneficial out-
comes of TCM gynecological practice and nursing on the
various gynecological and obstetrical disorders, such as
menopause [21], infertility [16], dysfunctional uterine
bleeding (DUB) [22], labor pain [23], and breast cancer
nursing [24] .
5. Conclusions
TCM harbors a long history in regards to treating gyne-
cological disorders and provides unique gynecological
nursing. With therapeutic and nursing modalities, they
are effective systems of understanding and managing
woman health as proven by medical literatures, clinical
benefits and basic research studies. TCM and conven-
tional medicine share common goals in gynecology and
nursing: benefit woman and guarantee human reproduce-
6. Acknowledgements
This study was supported by National Science Funds of
China under grant number, 81072719.
7. Conflict of Inter e st S ta t e me nt
No conflict of interest declared.
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